Mastering the antegrade femoral artery access in patients with symptomatic lower limb ischemia: Learning curve, complications, and technical tips and tricks

Background: Antegrade femoral access is fraught by technical challenges and steeper learning curve, in comparison with retrograde contralateral femoral access. We appraised learning curve, complications, and technical aspects inherent in the adoption of antegrade approach. Methods: Consecutive cases...

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Bibliographic Details
Published in:	Catheterization and cardiovascular interventions Vol. 68; no. 6; pp. 835 - 842
Main Authors:	Biondi-Zoccai, Giuseppe G. L., Agostoni, Pierfrancesco, Sangiorgi, Giuseppe, Paola, Luca Dalla, Armano, Fabio, Nicolini, Simone, Alek, Josef, Fusaro, Massimiliano
Format:	Journal Article
Language:	English
Published:	Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-12-2006
Subjects:	Aged arterial access Arterial Occlusive Diseases - surgery Catheterization, Peripheral - adverse effects Catheterization, Peripheral - methods Clinical Competence critical limb ischemia Education, Medical, Continuing - methods Female Femoral Artery - surgery Humans Ischemia - surgery learning curve Leg - blood supply Limb Salvage - education Male Minimally Invasive Surgical Procedures - adverse effects Minimally Invasive Surgical Procedures - education Obesity - complications peripheral artery disease Peripheral Vascular Diseases - surgery
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Summary:	Background: Antegrade femoral access is fraught by technical challenges and steeper learning curve, in comparison with retrograde contralateral femoral access. We appraised learning curve, complications, and technical aspects inherent in the adoption of antegrade approach. Methods: Consecutive cases in which antegrade access was attempted by a cardiologist experienced in retrograde access, but inexperienced in antegrade, under supervision of an operator with anterograde expertise, were collected. The primary end‐point was the occurrence of antegrade access failure or local complications. Major complications were defined as those life‐threatening, requiring transfusion, percutaneous, or surgical repair. Results: Anterograde access was attempted in 120 patients. The primary end‐point occurred in 14 (11.6%) cases, but according to the learning curve, in 12 (20%) for first 60 cases vs 2 (3.3%) for the last 60 cases (P = 0.008). Access failure in the hands of the in‐training operator was similarly found in all cases but one during the first 60 cases. No major complications occurred, while minor complications were found in 9 (7.5%) patients, again with all but two of them occurring in the first 60 cases. These included peri‐adventitial extravasation in 8 patients (6.7%), and perforation of a small branch in one (0.8%); all these complications were conservatively and successfully managed. Obesity was the only significant predictor of access failure/complication (P = 0.004). Conclusions: This work, the first to report on the learning curve of the antegrade approach, supports the feasibility and safety of this access site even for an in‐training operator, if supervised. A minimum caseload of 60 procedures is likely needed to master this technique. © 2006 Wiley‐Liss, Inc.
Bibliography:	istex:614129924A4C26A052B887CA85636D3F23409B33 ArticleID:CCD20930 ark:/67375/WNG-JK7T31B8-L ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1522-1946 1522-726X
DOI:	10.1002/ccd.20930